Tuesday, June 25, 2013

In Which Our Heroine wonders if she has perhaps gone too far

Below is the email I sent my incoming team of interns and medical students with my expectations for the following Medicine Wards rotation.

Have I gone too far?

Hello to everyone, and welcome to (name of hospital) Floors Block One!

You will be working with me for the next month.  It's going to be a busy month and we will all need to work hard, but we will learn a lot and (I promise) have fun.


I have a some expectations that I want to set out.  I set a high bar but we have patients' lives in our hands and I take that responsibility seriously.  It is a privilege and an honor that should humble us.

1. If you have questions, just ask!  I almost never bite :o)  Don't ever be afraid a question is too foolish because I promise I probably asked or will ask the same thing.
2. I do NOT expect perfection, but I do expect a COMMITMENT TO PATIENT CARE.  That's what we're here for.  You don't have to get it right but you need to do your best and know your patients.
3. Your history should focus on the chronology.  Be complete.  Do not copy others' histories but take your own because you can't trust other people's histories.  You might need to call a nursing home or family member.  Medical students, this is often a good way you can contribute to the team!
4. You will do proper physical exams.  That means undress your patients!  Examining through clothes is unacceptable.  I expect a funduscopic exam on new patients and a basic neurologic exam (CN, DTRs, strength).  Bandages are to be uncovered unless they are post-surgical and the surgical team hasn't yet changed the dressing.  LOOK AT EVERY LINE/TUBE ON EVERY PATIENT EVERY DAY!
5. Patients' PCPs are to be contacted upon admission and discharge.  Medical students, this is again a key responsibility for you.
6. Our team reviews primary data.  This means: we do our own Gram's stains, review our own peripheral smears, examine our own urine sediments, and go to Radiology to review cases with the radiologist.  I will help you find all of these places so don't worry :o)
7. We will pre-round in the morning, probably a half-hour prior to rounds but this may change depending what the team's needs are.  On pre-rounds you will give me a brief update on the patient including the vitals from the last 24hrs, new test results, etc.
8. Update your nurses, and get updates from them!  They are valuable resources particularly for patients who can't speak for themselves.
9. Eyeball all your patients at the end of the day.  I promise it makes for much easier mornings.
10. Address code status.  Obviously you don't need to have a lengthy discussion with the twenty-five year old admitted w cellulitis.  But if somebody should be DNR, or should be hospice, address it!  We can go over some techniques.
11. Read something every day.  It doesn't have to be long.  But otherwise you won't grow.
12. Interns, I expect you to TEACH YOUR STUDENTS!
13. Students, ASK QUESTIONS!
14. PLEASE LET ME KNOW if there is ANYTHING I can do to enhance your experience, teach you better, etc.  I hope to go into academic medicine so I want to learn as much as I can about teaching.

Well, dear readers, what do you think?  I am still learning this Senior Resident thing.

In other news...still terrified something will go wrong with intermittent moments of relief.  Don't want to go to bed late so will elaborate later.

No comments:

Post a Comment